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21b - Answer: 28-year-old male presents with difficulty opening mouth wide

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 28-year-old male presents with difficulty opening mouth wide with right-sided pain and discomfort and popping since getting hit in the face with a soccer ball three years prior.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

Right TMJ: Flattening of the mandibular condyle with erosive changes and reactive osteoedema.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS: 

RIGHT: Marked anterior dislocation of the articular disc noted. The disc is intact. Partial lock. No evidence of perforation. No anterior translation of the condyle or reduction seen in the open-mouth position. Flattening of the mandibular condyle is identified with erosive changes and reactive osteoedema. The articular eminence is normal in contour.

LEFT: Nominal anterior displacement of the articular disc noted. Normal anterior translation of the mandibular condyle with reduction is noted in the open mouth position. The disc is normal in caliber and signal intensity. No perforation noted. Small lateral osteophyte is seen extending from the mandibular condyle. The articular eminence is normal in contour. 

The bone marrow signal is normal. No evidence of fracture or other osseous lesions. 

The visualized muscles are without abnormality. 

CONCLUSION: 

1. Marked anterior disc displacement without reduction or anterior translation of the condyle on the right. Partial lock.

2. Nominal anterior disc displacement with reduction on the left. Normal translation. 

3. Flattening of the right mandibular condyle and lateral osteophytosis of the left mandibular condyle.

LESSON 2, TOPIC 63

Case Challenge: Temporomandibular Joint (TMJ) MRI Cases

Case Challenge

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Content reviewed: August 31, 2021

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